Within these hours, I conducted a face to face consultation with a new client and completed the notes and any necessary research after.
Reflective Summary
The client appeared to present with a medial meniscus sprain as they had medial joint line tenderness and were positive for Thessalys special test (Doral, Bilge, Huri, Turhan & Verdonk, 2018). Moreover, I could understand from the subjective history that the mechanism of injury was trauma related and involved twisting on a loaded flexed knee. All of these factors influenced the clinical impression, especially as ligament damage was ruled out using other special tests.
The meniscus are fibrocartilogious structures that have many functions including load transmission, shock absorption, reducing joint contact stresses and providing joint lubrication (Giuliani, Burns, Svoboda, Cameron & Owens, 2011). I advised the client to reduce loading of the knee in order to help with the tissue healing process; weight-bearing can cause distraction and displacement of a radial, complex and root tear which can negatively affect the tissue healing process (Khalifa, Mohamed, Abo-Zeid & Abd-Elaal, 2020).
It is consistently reported in the literature that the management of meniscal injuries should include quadricep and hamstring strengthening, eventually progressing to dynamic proprioceptive training (Chirichella et al., 2019). As the client is already very active, I suggested for them to add more hamstring strengthening into their gym programme as this could also help with their hyper mobility. Exercises included glute bridges (using sliders), nordic hamstring curls and single leg Romanian deadlifts which begins to challenge dynamic proprioception. Next time I will look to implement exercises specific for gluteus medius as a study by Kim (2016) found that adductor squeezes and standing side abduction with a theraband improved knee function and pain, however the population is not specific to my client as the participants in this study had received surgery on the meniscus.
What Went Well
I believe I rationalised my clinical impression well and provided specific treatment and exercises based off of evidence based research.
| Areas for Improvement | Action Plan |
| Be more confident when conducting the special tests. | Continue to practice with my housemates to ensure I have the correct positioning and am optimally performing the test. |
| When the client comes in for a face to face appointment, remember to check if they have any changes to the COVID-19 questions. | Next time I am in clinic, check this with the client. |
Closing the Loop
Since looking back on this experience, each week I have been revising a specific joint including the special tests which can be used. I also ensure that the client has so changes to the COVID-19 related questions when they arrive at clinic.
References
Chirichella, P. S., Jow, S., Iacono, S., Wey, H. E., & Malanga, G. A. (2019). Treatment of knee meniscus pathology: rehabilitation, surgery, and orthobiologics. PM&R, 11(3), 292-308.
Doral, M. N., Bilge, O., Huri, G., Turhan, E., & Verdonk, R. (2018). Modern treatment of meniscal tears. EFORT Open Reviews, 3(5), 260-268.
Giuliani, M. J. R., Burns, M. T. C., Svoboda, L. S. J., Cameron, K. L., & Owens, L. B. D. (2011). Treatment of meniscal injuries in young athletes. The Journal of Knee Surgery, 24(02), 93-100.
Khalifa, A. A., Mohamed, R. A. E., Abo-Zeid, A. R., & Abd-Elaal, A. M. (2020). Rehabilitation options for patients with an isolated meniscal tear, a narrative review. Sports Orthopaedics and Traumatology, 1-6.
Kim, E. K. (2016). The effect of gluteus medius strengthening on the knee joint function score and pain in meniscal surgery patients. Journal of physical therapy science, 28(10), 2751-2753.